Paper

More than 500,000 cases of severe sepsis are initially managed in the US emergency departments annually, with an average ED length of stay of 5 hours. The cornerstones of management of severe sepsis includes prompt diagnosis, timely administration of appropriate antibiotics, and aggressive resuscitation.

There is a disease continuum with increasing severity if not treated or not responsive to treatment o Sepsis

Patient Outcomes. The best possible outcome for every patient is to be able to return home, without additional harm/infection during their hospital stay. The ultimate goal is for the patient to have the best possible chance of returning to the quality of life they had before the cause of their admission. A patient who experiences a HAPU is at a significantly greater risk of infection, sepsis, and even death, making HAPU prevention a priority outcome for patient, staff, family and facilities around the globe.

Furthermore, prompt infusion of antimicrobial agents ought to be priority and this may require extra vascular access ports (Dellinger, et al., 2008). Early goal-directed resuscitation has confirmed to improved survival for emergency department patients presenting with septic shock in a randomized, controlled, single-center study. Resuscitation lessen 28-day death rate (Dellinger, et al., 2008). In a reviewed conducted by Dellinger, et al., (2012) advocated administering one litre of crystalloid or 300-500ml of colloid more than 30 minutes, to accomplish a central venous pressure (CVP) of 8 mm Hg to 12 mm Hg. Volumes ought to be increased if there are huge indications of hypoperfusion (Dellinger, 2014).

is one of the leading causes of death among hospitalized patients (Alberti et al., 2003). It

Sepsis is the body’s response to infection. The onset of sepsis is often undetected until the condition has become critical. Sepsis progresses into severe sepsis, septic shock, and eventually death; typically from organ failure. The condition affects over 500,000 individuals annually, has a mortality rate of over 25%, and presents a risk to patients in every inpatient setting regardless of acuity level (Whelchel et al., 2011). My first experience with sepsis was enlightening because it affected a patient under my care. I was surprised at the insidious onset of the symptoms, the rapid decline in the patient’s condition, and the missed opportunities that the healthcare team had to implement the recommended care bundle protocols.

Ans: It is crucial to start prophylactic therapies with penicillin if patients not allergic to its ingredients, IV fluids in the cases of low blood pressure, and maintaining the airway to alleviate dyspnea while waiting for the causes of sepsis so that the right treatment can be

Sepsis still represents a major cause of morbidity and mortality in critically ill patients despite the use of modern antibiotics and resuscitation therapies. There is a lack of early diagnosis and timely intervention for sepsis in the emergency department (ED), and recent interest has focused on biomarkers for early diagnosis, risk stratification, and evaluation of prognosis of sepsis.

Sepsis is a life-threatening response to an infection and is the leading cause of death for hospitalized patients. It is estimated that 1.6 million hospitalized patients are treated for sepsis annually, with the approximate health care cost of $16.7 billion dollars. The mortality rate for sepsis is estimated to be as high as fifty percent. However, research evidence shows that early detection of sepsis can improve survival rates by twenty percent (Winterbottom, 2012, p. 247). In 2010, the Surviving Sepsis Campaign created evidence-based guidelines to improve outcomes for patients with early sepsis, and to create awareness and education for health care professionals regarding the impact of early detection (Levy et al., 2010). Recommendations for the early detection of sepsis include specific monitoring of lab work and vital signs, goal-directed therapy such as fluid replacement, and the early administration of the appropriate board-spectrum antibiotic’s.

Ventilator-associated pneumonia (VAP) remains a big drawback within the hospital setting, with terribly high morbidity, mortality, and cost. Some people tend to perform an evidence-based review of the literature that specializes in clinically relevant pharmacological and non-pharmacological interventions to prevent VAP. Thanks to the importance of this condition the implementation of preventive measures is predominant within the care of mechanically ventilated patients. There is proof that these measures decrease the incidence of VAP and improve outcomes within the intensive care unit. A multidisciplinary approach, continuing

Six studies were conducted in Midwestern hospitals (Carayon et al., 2007; DeYoung et al., 2009; Harrington et al., 2013; Ludwig-Beymer et al., 2012; Morriss et al., 2011; Seibert et al., 2014). One study was conducted in a western hospital in the United States (Hardmeier et al., 2014), one in New England hospitals (Richardson et al., 2012) and one study was conducted in a hospital in the Netherlands (Van Onzenoort et al., 2008). Two studies were conducted throughout the United States (Koppel et al., 2008; Mims et al., 2009). Of the thirteen studies, eleven were cross sectional observational studies while the remaining two were literature reviews (Keane, 2014; Young et al., 2010).

Assessment Although a patient in severe sepsis may be transferred to the intensive care unit (ICU), medical-surgical nurses must be able to recognize early signs and symptoms of sepsis to ensure prompt treatment before the patient requires ICU admission. Severe sepsis Severe sepsis occurs when a patient with documented sepsis goes on to develop acute organ dysfunction with hypoperfusion and tissue hypoxemia. Simple prevention strategies Without proper assessment and early identification, patients with sepsis can deteriorate quickly, suffering compromised tissue oxygenation and organ dysfunction for many hours. Be aware that although blood pressure readings are crucial in assessing and planning care for the septic patient, mean arterial pressure

Two investigators (CJC & SG) and the medical librarian (SP) independently reviewed the identified abstracts. All potential relevant studies were obtained and critically appraised. We used the following inclusion criteria 1) diagnosed sepsis or septic shock 2) on β- blockers or treated with β-blockers during their ICU admission 3) adult population (age >18 or older). Exclusion criteria were 1) paediatric patient’s 2) animal studies 3) non-septic patients. The eligible studies were heterogeneous and therefore did not permit statistical pooling.

Tazbir (2012) and Schorr, Odden, Evans, Escobar, Bandi, Townsend, and Levy (2016) developed articles that are specific to the medical-surgical unit and defined several factors as to what may play into the higher mortality rate of the patients that are diagnosed there. Schorr et al. (2016) further examined and compared emergency department (ED) versus medical surgical treatment of sepsis. Kleinpell, Aitken, and Schorr (2013) gave thorough, in-depth knowledge of nurses’ role, sepsis, and treatment guidelines describing initial, three-hour, and six-hour bundles. Medley O’Keefe, Gatewood, Wemple, Greco, Kritek, and Durvasula (2015) gave interesting statistics to support nurse-driven testing and sepsis-specific goal-directed therapy. Lopez-Bushneil, Demaray, and Jaco (2014) and Kleinpell (2017) defined sepsis screening tools with complete sepsis protocols and identified studies in which nurses are authorized to identify signs and symptoms, order necessary blood testing, and initiate protocols. Additionally, Kleinpell (2017) identified studies in which nurses completed “Sepsis Power Hour” in which blood cultures, lactate, and fluid boluses were independently initiated by the nurse. All articles were chosen because they appeared to have a strong hierarchy of evidence. For example, Lopez-Bushneil, Demaray, and Jaco (2014) report testing evidence to show a change in practice due to the exceeded goals and successful treatment of

Patients who required cooling as part of their treatment, or who had hyperthermic disorders in which the cause of fever was not the infection were also excluded. Patients who were expected to die within 24h or who had advanced directives barring the use of aggressive life-saving measures were also excluded. Pregnant patients were excluded as the study’s authors hypothesize acetaminophen use is potentially harmful to the patient. Patients who were not expeditiously enrolled and did not start the study protocol within 12h of ICU admission were excluded. The rationale for these seems appropriate to rule out patients who do not fit the study’s parameters and who might bias the